Agility: 2024 ACA Training and Resources for Health Insurance Agents & Brokers.

The Patient Protection and Affordable Care Act, commonly referred to as the ACA or ‘Obamacare’, was enacted in March 2010. The ACA was passed with the goal of lowering the number of uninsured individuals through enrollment in private insurance and the expansion of public insurance coverage (Medicaid). It also looks to increase the quality and affordability of health insurance with subsidies (through “premium tax credits” and “cost-sharing reductions”) and health insurance marketplaces.

Expanded and Enhanced Subsidies Through 2025

Expanded and enhanced marketplace premium subsidies, enacted under the American Rescue Plan Act (ARPA), took effect in 2021 and remain in effect for 2025. The recently passed Inflation Reduction Act (IRA) ensures that the ARPA’s subsidies continue without interruption for an additional three years, through 2025.

Just like the ARPA, the enhanced subsidies in the Inflation Reduction Act reduce costs across the board by further lowering payments for people who were already eligible for subsidies under the original ACA subsidy structure and by extending subsidy eligibility to middle-income people by removing the upper income limit on subsidies.

The subsidy now fully covers the cost of enrolling in the benchmark silver plan for consumers with income up to 150% of the federal poverty level (FPL). With the original ACA subsidy structure, consumers at 150% FPL ($20,385 for a single person in 2023, or $41,625 for a family of 4) had to pay about 4% of household income for the benchmark plan. By reducing premium contributions to $0 (or near $0), the Inflation Reduction Act essentially guarantees access to silver plans with generous cost sharing reductions that substantially reduce deductibles and copays.

The Inflation Reduction Act, like the ARPA before it, extends eligibility for premium tax credits to reach people with incomes over 400% FPL ($54,360 for a single person in 2023, or $111,000 for family of 4). Now these consumers must contribute no more than 8.5% of their income toward the benchmark silver plan. This change is especially beneficial to older marketplace consumers (50 and older) whose premiums are age-adjusted in most states and can be up to 3 times that of young adult premiums for the same policy. The average unsubsidized silver plan premium for a 60-year-old couple in 2023 is more than $1,900 per month in 2023. Under the original ACA subsidy structure, subsidies were unavailable to people with incomes above 400% FPL, meaning premiums for older enrollees could easily cost more than 20% of their household income. But now, premium payments are capped at no more than 8.5% of household income.

Source: Cynthia Cox, Karen Pollitz, Krutika Amin, and Jared Ortaliza, Nine Changes to Watch in ACA Open Enrollment 2023, (KFF, Oct 27, 2022) https://www.kff.org/policy-watch/nine-changes-to-watch-in-open-enrollment-2023/ (10/30/2022).

Millions of people now eligible for marketplace subsidies

Until this year, an estimated 5.1 million people were ineligible for marketplace subsidies because of the family glitch. Generally, people are ineligible for marketplace subsidies if they have an offer of “affordable” job-based coverage – including through a family member’s job. However, until 2023, the affordability of job-based coverage for a worker’s spouse and dependents only measured the premium contribution required for the worker’s self-only coverage. As a result, if an employer coverage offer met the affordability threshold (9.12% of income in 2023) for self-only coverage but not for family coverage, those family members were nonetheless considered to have an offer of “affordable” job-based health coverage and locked out of ACA marketplace subsidies.

New rules will take effect for the 2023 coverage year, measuring the affordability of family coverage based on the worker’s premium contribution for family coverage. If that amount is more than 9.12% of household income in 2023, family members will have the option of buying health coverage through the Marketplace and will be eligible for premium tax credits based on their income.

Marketplace rules have been relaxed for those who fell behind on premium payments

Pre-enrollment verification eliminated except for SEPs due to loss of other coverage

Once Open Enrollment ends, people will continue to be able to sign up for Marketplace coverage mid-year if they have a qualifying life event (such as loss of other coverage, marriage or divorce, or a permanent move) using a 60-day special enrollment period (SEP). In HealthCare.gov states, people had been required to first complete a pre-enrollment verification process by providing documentation of their qualifying event that made them eligible for an SEP. People who could not provide such documentation within 30 days often were denied the SEP.

Starting in 2023, HealthCare.gov will only require pre-enrollment verification for SEPs due to loss of other prior coverage. For other qualifying events (marriage, divorce, permanent move, etc.) people will be able to self-attest to their eligibility and proceed to enroll in coverage during their SEP.

Agents and brokers who completed plan year 2024 Individual Marketplace registration and training will be eligible to take a new half-hour training for plan year 2025, as well as optional review modules.Returning agents and brokers can take Individual Marketplace training either through the Marketplace Learning Management System (MLMS) or the CMS-approved vendor regardless of how they completed the plan year 2024 training.

Check out the guide below for returning agents and brokers to help you through the registration and training steps and process.

Since January 1, 2014, consumers and small businesses in every state (including the District of Columbia) have had access to obtain health insurance coverage through Health Insurance Exchanges operated by States through State-based Exchanges (SBEs), State-based Exchanges on the Federal platform (SBE-FPs), or operated by the Federal government through the Federally-facilitated Marketplace (FFM).

Below is a list of the SBEs along with the state's website link for consumers, agent training links, and any additional notes.

If 'License Status' is not Complete, then you must apply for an insurance license in your Resident State.
If 'Approved LOA Name' is not Complete, then you likely have a license in your Resident State, but you do not have the correct Line of Authority (for example, you have a Property & Casualty License but not a Health License). In this instance, apply for the correct line of authority in your Resident State.
If 'LOA Active' is not Complete, then you have a license with the correct Line of Authority, but you do not have an appointment with a health-related insurance company. In this case, get appointed now by requesting carrier contracting through Agility!

IMPORTANT: NEW REQUIREMENT!
Verify that your 'Valid NPN' Status is 'Complete'. To be validated, you must have a valid state license, have a valid health-related line of authority (LOA), and have an active status for your health-related LOA.

Agents and brokers who do not have an approved health-related LOA, as determined by their resident state, will not be able to access Marketplace systems and will not be able to assist consumers with Marketplace activities for Plan Year 2025.

Your NPN Validation should look like this:

Below is a list of the SBEs along with the state's website link for consumers, agent training links, and any additional notes.

State	Coverage Map	Training	Network	Drug Coverage
AL	Map	Training	Network	Coverage
AZ	Map	Training	Network	Coverage
AR	Map	Training	Network	Coverage
CA				Coverage
FL	Map	Training	Network	Coverage
GA	Map	Training	Network	Coverage
IL	Map	Training	Network	Coverage
IN	Map	Training	Network	Coverage
KS	Map	Training	Network	Coverage
KY	Map	Training	Network	Coverage
LA	Map	Training	Network	Coverage
MI	Map	Training	Network	Coverage
MS	Map	Training	Network	Coverage
MO	Map	Training	Network	Coverage
NE	Map	Training	Network	Coverage
NV	Map	Training	Network	Coverage
NH	Map	Training	Network	Coverage
NJ	Map	Training	Network	Coverage
NM	Map	Training	Network	Coverage
NC	Map	Training	Network	Coverage
OH	Map	Training	Network	Coverage
OK	Map	Training	Network	Coverage
PA	Map	Training	Network	Coverage
SC	Map	Training	Network	Coverage
TN	Map	Training	Network	Coverage
TX	Map	Training	Network	Coverage
WA	Map	Training	Network	Coverage

Products & Marketing such as Summaries of Benefits, Plan Comparison Charts, Sizzle Sheets, and Customizable Marketing Fliers
Enrollment Support including the BCSBTX Application Tracker, the Retention Call Center, and Sample Renewal Packets
The Retail Producer Portal including guides to creating quotes, enrolling and managing clients, and registering for the Portal.
Premiums & Payments including Initial Payment Information, Pay My Bill Sites, One-time Payment Options, Automatic Payment Authorization Forms, Grace Period Rules, and Pay by Phone info.
Service & Support including Find a Pharmacy, Prescription Drug Lists, and Pharmacy Programs

Carrier Contracting

Agent Training & Compliance

HealthSherpa ACA Enrollment Platform

ACA Background & Updates

Carrier Products & Materials

Supporting Your Clients & BOB

Sales Tips & Opportunities

General Links & Resources

ACA Background & Updates

Federal Poverty Guidelines for Plan Year 2025

Medicaid Expansion by State

Marketplace Types by State

Expanded & Enhanced Subsidies Through 2025

Family Glitch Fixed

Relaxed Rules on Past Due Premium & SEP Verification

ACA Training & Compliance

FFM Training for New and Returning Agents

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ACA Resources by Carrier

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